As an employer or employee, there are many important forms that must be completed for COBRA insurance. Use the COBRA insurance forms below to better understand what COBRA insurance forms normally look like and what you can expect during the process. These forms are just examples, provided by the Department of Labor, and should not be used to elect COBRA insurance. Your employer will provide you with the proper forms for your specific company, health insurance plan, and situation. Always fill out the forms carefully to ensure you are able to continue your COBRA insurance.

COBRA Continuation Coverage Election Notice Sample

A sample COBRA health insurance election form that employees would fill out to elect COBRA.

COBRA Continuation Coverage Extended Election Notice Sample

A sample COBRA health insurance election form for employees and covered beneficiaries eligible for extended coverage.

COBRA Continuation Coverage-Supplemental Notice Sample

A sample COBRA health insurance form for supplemental COBRA insurance care.